Ever wonder if you locked the doors or left the stove on? Ever have the feeling that something terrible was about to happen? Do you have certain routines that you follow in the morning or evening? These thoughts and simple routines are not unusual. However, for the person with OCD, these thoughts and routines occur repeatedly, and the individual feels unable to stop them. Moreover, these thoughts and behaviors cause significant distress and interference in the individual’s life. When “checking behavior” or other compulsions take hours, not minutes, of a person’s day, therapists consider this to be OCD. Typical obsessions include fears of contamination or poisoning, religious themes, doubts, and thoughts of sex. Compulsions are often desperate attempts to “neutralize” the obsession and anxiety, and involve repeating some behavior such as washing, checking, counting, tapping or touching things repeatedly.

Common Obsessions and Compulsions

When many of us think about OCD, we think of the most well-known symptoms, such as excessive hand-washing or keeping things in order. However, there are many ways in which OCD manifests and can be addressed in treatment. Common reasons why people with OCD seek treatment include, but are not limited to:

Persistent anxiety that something bad will happen to loved ones, particularly if a certain ritual is not performed

Fear of getting sick or contaminated, either in general, or with respect to specific diseases; Repeated washing, showering, decontaminating, or research into diseases and how they are contracted

Feeling dirty, contaminated, or unclean, without fear of actual illness. The contamination may be by something physically dirty, or by objects or people thought to have something wrong or undesirable about them

Fear of losing control and hurting one’s self or others (e.g., hurting loved ones with a knife, pushing someone into the street)

Fear of being responsible for harm to others due to negligence (e.g., one’s careless may start a fire or cause someone to slip and fall)

Worries about having hit someone while driving and checking repeatedly

Need for things to feel “just right,” leading to repetitive cleaning, ordering, arranging, light switching, door or window-locking, walking up and down stairs or through doors, and more

Fears about having inappropriate sexual thoughts; These may be violent images, or related to people that it feels perverse to have thoughts about, such as family members, children, or a gender that one does not want to be attracted to

Fears about offending God or imperfect adherence to one’s religious requirements (Religious rituals themselves are not compulsions, but fear of not following the rules properly to a degree that is significantly beyond what others in one’s community experience may be)

Fear of forgetting things, not understanding things sufficiently, not making one’s self perfectly understood, or “needing to know” something; Repeated questions to neutralize these obsessions

Compulsions around counting or doing things in multiples of certain “good” numbers or on “good” dates and/or avoidance of “bad numbers”

Fear that one may do or say something inappropriate in social or work situations, such as blurting out obscenities

Inordinate perfectionism

Treatment

The most effective form of psychotherapeutic treatment for OCD is a particular type of Cognitive Behavioral Therapy called Exposure and Response Prevention (ERP). In ERP, the individual works together with the therapist to confront the thoughts, people, things, and situations that are the focus of their obsessions and trigger their discomfort. The key element of this treatment is the response prevention aspect, in which the individual makes the choice – in the service of improving their lives in the long run – to refrain from doing the compulsions/rituals that they typically rely on, whether it be washing, performing a ritual, asking questions, repeating things, or trying to push thoughts away or otherwise deny them.

By breaking this cycle of obsessions and rituals, most individuals will find that their anxiety and discomfort will eventually decrease without having to do the ritual. At the outset, this may take longer. But by repeating these exercises over time, individuals build up a level of comfort with the situations that were previously thought to be unbearable. As this happens, individuals may begin to think differently about their obsessions, finding that these warnings of inescapable danger that the OCD insists upon are exaggerated, and that the situations are in fact survivable and less threatening than initially feared. As this comfort level grows, individuals with OCD can begin to reclaim the hours of their lives occupied by the condition.

To some, this approach may sound counterintuitive at first. Many seek treatment to make these thoughts and feelings go away rather than to confront them. However, it is often because of this desperately wanting to feel better and think differently that many get stuck in that escalating cycle of obsessions, compulsions, and worse obsessions. ERP is a choice to take a different approach from the one many are stuck in, one that may be quite challenging at first, but life-altering and positive in the long-run.

An essential ingredient of the process is an experienced and compassionate therapist who will work with the individual to move along at the right pace, provide support, and troubleshoot potential obstacles.